Displaced Acetabular Fracture in Elderly Patients: Is Acute Arthroplasty an Effective Option?

2019 ◽  
Vol 157 (06) ◽  
pp. 676-683 ◽  
Author(s):  
Zhengming Yang ◽  
Stephan Maximillian Röhrl ◽  
Lars Nordsletten
Keyword(s):  
Systematic Review ◽  
Elderly Patients ◽  
Acetabular Fracture ◽  
Treatment Options ◽  
Treatment Recommendation ◽  
Acetabular Fractures ◽  
Review Of The Literature ◽  
Effective Treatment Option ◽  
Elderly Individuals ◽  
Effective Option

Abstract Background and study aim Elderly individuals are the most rapidly growing subgroup of patients currently sustaining acetabular fractures, and total hip arthroplasty (THA) is being applied more and more in the treatment of acetabular fractures. The purpose of this study was to review the available literature regarding displaced acetabular fractures in elderly patients treated with acute THA. Study design A search was conducted using the electronic databases Medline, PubMed, ISI Web of Knowledge, and Scopus on papers published between January 1960 and November 2018 using the terms “acetabular fracture” plus “elderly patients” plus “arthroplasty”. A systematic review of the literature on the different treatment options for acute THA is presented. Results The search yielded a total of 320 articles, and 9 articles were selected for review. The indications, techniques, approaches, and complications of THA are discussed, and a treatment recommendation based on the selected articles is given. Conclusion We consider acute arthroplasty an effective treatment option for displaced acetabular fractures in elderly patients, while different techniques should be used for different displaced acetabular fractures in this patient group.

scholarly journals Indications and outcomes of enterovesical and colovesical fistulas: systematic review of the literature and meta-analysis of prevalence

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stefano Granieri ◽  
Francesco Sessa ◽  
Alessandro Bonomi ◽  
Sissi Paleino ◽  
Federica Bruno ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Symptoms ◽  
Rare Complication ◽  
Meta Analysis ◽  
Treatment Options ◽  
Palliative Surgery ◽  
Review Of The Literature ◽  
Colovesical Fistula ◽  
Level Of Evidence ◽  
Meta Analyses

Abstract Background Entero-colovesical fistula is a rare complication of various benign and malignant diseases. The diagnosis is prominently based on clinical symptoms; imaging studies are necessary not only to confirm the presence of the fistula, but more importantly to demonstrate the extent and the nature of the fistula. There is still a lack of consensus regarding the if, when and how to repair the fistula. The aim of the study is to review the different surgical treatment options, focus on surgical indications, and explore cumulative recurrence, morbidity, and mortality rates of entero-vesical and colo-vesical fistula patients. Methods A systematic review of the literature was conducted according to PRISMA guidelines. Random effects meta-analyses of proportions were developed to assess primary and secondary endpoints. I2 statistic and Cochran’s Q test were computed to assess inter-studies’ heterogeneity. Results Twenty-two studies were included in the analysis with a total of 861 patients. Meta-analyses of proportions pointed out 5, 22.2, and 4.9% rates for recurrence, complications, and mortality respectively. A single-stage procedure was performed in 75.5% of the cases, whereas a multi-stage operation in 15.5% of patients. Palliative surgery was performed in 6.2% of the cases. In 2.3% of the cases, the surgical procedure was not specified. Simple and advanced repair of the bladder was performed in 84.3% and 15.6% of the cases respectively. Conclusions Although burdened by a non-negligible rate of complications, surgical repair of entero-colovesical fistula leads to excellent results in terms of primary healing. Our review offers opportunities for significant further research in this field. Level of Evidence Level III according to ELIS (SR/MA with up to two negative criteria).

scholarly journals Effectiveness of web-based feedback interventions for people with overweight and obesity: systematic review and network meta-analysis of randomized controlled trials

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Carmen Varela ◽  
Camila Oda-Montecinos ◽  
Ana Andrés ◽  
Carmina Saldaña
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Weight Control ◽  
Meta Analysis ◽  
Treatment Options ◽  
Overweight And Obesity ◽  
Mean Difference ◽  
Effective Treatment Option ◽  
Web Based ◽  
Self Help

Abstract Background Web-based delivered interventions have become an innovative option to treat health problems, like obesity. The aim of this systematic review and network meta-analysis was to analyze the effectiveness of web-based behavioral treatments for adults with overweight and obesity. Web-based interventions and comparison interventions (traditional weight control programs) were classified according to the following feedback characteristics: frequency, personalization, and provider (human versus machine). Method From the initial 1789 studies, 15 were included in this review. A network meta-analysis was conducted to analyze the efficacy of web-based programs with traditional interventions, considering direct and indirect comparisons. The main outcome was the weight loss mean difference (kg) between baseline and post-treatment. Heterogeneity and consistency assumptions were validated to conduct the network meta-analysis. Results Network meta-analysis showed comparisons between different treatment options. The main results were that Intensive Contact Web-based programs were more effective than wait-list (Mean Difference − 1.86 kg; 95% Confidence Interval: − 3.61, − 0.12). Moreover, Intensive Contact Web-based programs were more effective than the other web-based options and self-help traditional interventions. However, the only significant comparison was Intensive Contact Web-based programs versus Guided Self-Help Web-based programs (Mean Difference − 4.31 kg; 95% Confidence Interval: − 5,22, − 3,41). Intensive Contact Web-based programs were the most effective treatment option according the obtained results, achieving the first place in the ranking provided by the network meta-analysis with 98.5% of probabilities. Conclusions Intensive Contact Web-based interventions have obtained the first position in the ranking, proving the relevance of frequent, personalized, and professional feedback and their association with a better prognosis for people with overweight and obesity. These results provide relevant information to design more effective treatments for people with overweight and obesity, in a new format especially appropriate for the current situation.

scholarly journals Does Conservative Kidney Management Offer a Quantity or Quality of Life Benefit Compared to Dialysis? A Systematic Review

2021 ◽  
Author(s):  
Buur Louise Engelbrecht ◽  
Madsen Jens Kristian ◽  
Eidemak Inge ◽  
Krarup Elizabeth ◽  
Lauridsen Thomas Guldager ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Treatment Options ◽  
Symptom Burden ◽  
Place Of Death ◽  
Cochrane Library ◽  
Elderly Individuals ◽  
Secondary Outcomes ◽  
The Cochrane Library

Abstract Background Patients with stage 5 chronic kidney disease (CKD5) collaborate with their clinicians when choosing their future treatment modality. Most elderly patients with CKD5 may only have two treatment options: dialysis or conservative kidney management (CKM). The objective of this systematic review was to investigate whether CKM offers a quantity or quality of life benefit compared to dialysis for some patients with CKD5.MethodsThe databases MEDLINE, EMBASE, the Cochrane Library, and CINAHL were systematically searched for studies comparing patients with CKD5 treated with CKM or dialysis. The primary outcomes were mortality and quality of life (QoL). Hospitalization, symptom burden, and place of death were secondary outcomes. For studies reporting hazard ratios, pooled values were calculated, and forest plots conducted.ResultsTwenty-four primary studies, all observational, were identified. All studies except one reported an increased mortality in patients treated with CKM (pooled hazard ratio 0.53, 95% confidence interval 0.41-0.69). For patients aged ≥ 80 years and for elderly individuals with comorbidities, results were ambiguous. In most studies, CKM seemed advantageous for QoL and secondary outcomes. Findings were limited by the heterogeneity of studies and biased outcomes favouring dialysis.ConclusionsIn general, patients with CKD5 live for a shorter time on CKM than on dialysis. In patients aged ≥ 80 years old, and in elderly individuals with comorbidities, the survival benefits of dialysis seem to be lost. Regarding QoL, symptom burden, hospitalization, and place of death, CKM may have advantages. Higher quality studies are needed to guide patients and clinicians in the decision-making process.

Identifying stakeholder opinion regarding access to “high-cost medicines”: A systematic review of the literature

Open Medicine ◽  
2014 ◽  
Vol 9 (3) ◽  
pp. 513-527 ◽  
Author(s):  
Philip Wahlster ◽  
Shane Scahill ◽  
Sanjay Garg ◽  
Zaheer-Ud-Din Babar
Keyword(s):  
Systematic Review ◽  
Ethical Issues ◽  
Treatment Options ◽  
System Level ◽  
Research Articles ◽  
Original Research ◽  
Review Of The Literature ◽  
Moral Issues ◽  
The Public ◽  
Patient Groups

AbstractObjective: To identify the viewpoints and perceptions of different stakeholders regarding high cost medicines (HCMs). Methods: A systematic review of the literature was performed to identify original research articles. Using predefined categories, data related to the viewpoints of different stakeholders was systematically extracted and analyzed. Results: Thirty seven original research articles matched the criteria. The main stakeholders identified include physicians, patients, public and health funding authorities. The influence of media and other economic and ethical issues were also identified in the literature. A large number of stakeholders were concerned about lack of access to HCMs. Physicians have difficulty balancing the the rational use of expensive drugs while at the same time acting as “patients’ advocate”. Patients would like to know about all treatment options, even if they may not be able to afford them. The process and criteria for reimbursement should be transparent and access has to be equitable across patient groups. Conclusion: Access to HCMs could be improved through transparency and involvement of all stakeholders, especially patients and the public. Moral issues and the “rule of rescue” could influence decision-making process significantly. At system level, objectivity is important to ensure that the system is equitable and transparent.

Rescue carotid puncture for ischemic stroke treated by endovascular therapy: a multicentric analysis and systematic review

2020 ◽  
pp. neurintsurg-2020-016725
Author(s):  
Julien Allard ◽  
Sam Ghazanfari ◽  
Mehdi Mahmoudi ◽  
Julien Labreuche ◽  
Simon Escalard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Elderly Patients ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Older Patients ◽  
Intravenous Thrombolysis ◽  
Review Of The Literature ◽  
Femoral Access ◽  
Life Threatening

BackgroundEndovascular therapy (EVT) for acute ischemic stroke (AIS) can be challenging in older patients with supra-aortic tortuosity. Rescue carotid puncture (RCP) can be an alternative in case of supra-aortic catheterization failure by femoral access, but data regarding RCP are scarce. We sought to investigate the feasibility, effectiveness and safety of RCP for AIS treated by EVT.MethodsPatients treated by EVT with RCP were included from January 2012 to December 2019 in the Endovascular Treatment in Ischemic Stroke (ETIS) multicentric registry. Main outcomes included reperfusion rates (≥TICI2B), 3 month functional outcome (modified Rankin Scale) and 3 month mortality. We also performed an additional systematic review of the literature according to the PRISMA checklist to summarize previous studies on RCP.Results25 patients treated by EVT with RCP were included from the ETIS registry. RCP mainly concerned elderly patients (median age 85 years, range 73–92) with supra-aortic tortuosity (n=16 (64%)). Intravenous thrombolysis (IVT) was used for nine patients (36%). Successful reperfusion was achieved in 64%, 87.5% of patients were dependent at 3 months, and 3 month mortality was 45.8%. The systematic review yielded comparable results. In pooled individual data, there was a shift toward better functional outcome in patients with successful reperfusion (median (IQR) 4 (2–6) vs 6 (4–6), p=0.011).ConclusionRCP mainly concerned elderly patients admitted for AIS with anterior LVO with supra-aortic tortuosity. The procedure seemed feasible, notably for patients treated with IVT, and led to significant reperfusion rates at the end of procedure, but with pronounced unfavorable outcomes at 3 months. RCP should be performed under general anesthesia to avoid life-threatening complications and ensure airways safety. Finally, RCP led to low rates of closure complications, emphasizing that this concern should not withhold RCP, if indicated.

scholarly journals Efficacy of Transcutaneous Transseptal Orbital Decompression in Treating Acute Retrobulbar Hemorrhage and a Literature Review

2014 ◽  
Vol 7 (1) ◽  
pp. 17-26 ◽  
Author(s):  
Rüdiger Zimmerer ◽  
Katrin Schattmann ◽  
Harald Essig ◽  
Philipp Jehn ◽  
Marc Metzger ◽  
...  
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Treatment Options ◽  
Orbital Decompression ◽  
Review Of The Literature ◽  
Orbital Trauma ◽  
Time Period ◽  
Retrobulbar Hemorrhage

Decreasing visual acuity secondary to orbital trauma may be caused by sudden space-occupying or expanding intraorbital lesions, including retrobulbar hemorrhage (RBH), herniation, or swelling. RBH must be diagnosed and treated immediately. This article addresses the efficacy of transcutaneous transseptal orbital decompression in a combination with a systematic review of the literature for a comparison of this method with existing treatment options. For this study the department's database was retrospectively screened for patients with acute RBH who were treated between 2009 and 2011 using the authors’ approach. Patients presenting with RBH were classified into RBH classes I to III according to three different clinical and radiological manifestations of acute RBH. The efficacy of transcutaneous transseptal orbital decompression was assessed by postoperative visual acuities. The literature review was performed by using the MEDLINE database. The time period for the study was between 2009 and 2011 during which 10 patients were diagnosed with suspected RBH and 9 were treated with the authors’ technique. Visual acuities were reconstituted or maintained in almost 86% of patients who were diagnosed and treated according to the authors approach and who survived initial trauma. It was concluded that transcutaneous transseptal orbital decompression provides an efficient and rapid approach for treating patients with acute RBH. By distinguishing three different manifestations of acute RBH, the authors present a diagnostic tool that may facilitate classification of RBH and determination of treatment options.

scholarly journals Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis? A systematic review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Buur Louise Engelbrecht ◽  
Madsen Jens Kristian ◽  
Eidemak Inge ◽  
Krarup Elizabeth ◽  
Lauridsen Thomas Guldager ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Treatment Options ◽  
Symptom Burden ◽  
Place Of Death ◽  
Cochrane Library ◽  
Elderly Individuals ◽  
Secondary Outcomes ◽  
The Cochrane Library

Abstract Background Patients with stage 5 chronic kidney disease (CKD5) collaborate with their clinicians when choosing their future treatment modality. Most elderly patients with CKD5 may only have two treatment options: dialysis or conservative kidney management (CKM). The objective of this systematic review was to investigate whether CKM offers a quantity or quality of life benefit compared to dialysis for some patients with CKD5. Methods The databases MEDLINE, EMBASE, the Cochrane Library, and CINAHL were systematically searched for studies comparing patients with CKD5 who had chosen or were treated with either CKM or dialysis. The primary outcomes were mortality and quality of life (QoL). Hospitalization, symptom burden, and place of death were secondary outcomes. For studies reporting hazard ratios, pooled values were calculated, and forest plots conducted. Results Twenty-five primary studies, all observational, were identified. All studies reported an increased mortality in patients treated with CKM (pooled hazard ratio 0.47, 95 % confidence interval 0.34–0.65). For patients aged ≥ 80 years and for elderly individuals with comorbidities, results were ambiguous. In most studies, CKM seemed advantageous for QoL and secondary outcomes. Findings were limited by the heterogeneity of studies and biased outcomes favouring dialysis. Conclusions In general, patients with CKD5 who have chosen or are on CKM live for a shorter time than patients who have chosen or are on dialysis. In patients aged ≥ 80 years old, and in elderly individuals with comorbidities, the survival benefits of dialysis seem to be lost. Regarding QoL, symptom burden, hospitalization, and place of death, CKM may have advantages. Higher quality studies are needed to guide patients and clinicians in the decision-making process.

scholarly journals Management of Digital Tendon Avulsion at the Musculotendinous Junction of the Forearm: A Systematic Review

Hand ◽  
2012 ◽  
Vol 7 (2) ◽  
pp. 134-142 ◽  
Author(s):  
Jessica Collins ◽  
Yoshihiro Ishihara ◽  
Achilleas Thoma
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Proximal Phalanx ◽  
Optimal Management ◽  
Challenging Problem ◽  
Review Of The Literature ◽  
Musculotendinous Junction ◽  
Patient Demographics ◽  
Work Accidents ◽  
Tendon Avulsion

Background Tendon avulsion at the musculotendinous junction caused by digit avulsion amputation or closed injury is a challenging problem, for which the literature lacks definitive recommendations regarding treatment. We have provided a systematic review and developed an algorithm to delineate optimal management of this injury. Methods Two independent reviewers undertook a systematic review of the literature to identify articles discussing management of forearm tendons avulsed at their musculotendinous junction. Patient demographics, injury mechanism, injury pattern, type of repair, and outcome were investigated. These data were analyzed to reveal tendencies in management, which were then organized into an algorithm. Results Twenty articles fit our criteria for a total of 91 tendons. Cases were mostly males involved in work accidents. Treatment options were tendon resection, reattachment to muscle, tendon transfer, and side-to-side repair. When the digit was replanted, tendons avulsed through avulsion amputations were preferentially treated by reattachment in the case of the thumb, transfers for the index and long fingers, and resection for the ring and small fingers. Reattachment was favored for metacarpophalangeal level amputations, while transfer was selected for proximal phalanx levels. For closed avulsion injuries, flexors were preferentially treated with reattachment or transfer, while extensors underwent transfer or side-to-side repair. Conclusions In the management of tendon avulsions at the musculotendinous junction, specific procedures are favored depending on the mechanism of injury, the type of tendon and digit involved, and the level of bone amputation. An algorithm is presented to facilitate optimal treatment based on these injury characteristics.

Current concepts about treatment options of plantar fibromatosis: A systematic review of the literature

2019 ◽  
Vol 25 (5) ◽  
pp. 559-564 ◽  
Author(s):  
Mario Fuiano ◽  
Massimiliano Mosca ◽  
Silvio Caravelli ◽  
Simone Massimi ◽  
Maria Grazia Benedetti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Review Of The Literature ◽  
Plantar Fibromatosis
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